Looman Wilhelmina Mijntje, Fabbricotti Isabelle Natalina, Huijsman Robbert
Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
Int J Integr Care. 2014 Dec 5;14:e034. doi: 10.5334/ijic.1010. eCollection 2014 Oct.
This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.
Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.
The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.
In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required to study the value of integrated care on changes in health and the preservation of the positive effects on quality of life and health care use.
本研究通过评估瓦尔赫伦综合护理模式在三个月后对健康、生活质量、医疗保健使用情况及护理满意度的影响，探讨综合护理对体弱老年人的短期价值。
使用格罗宁根衰弱指标对居家老年人进行衰弱的预防性检测。老年护理从业者和二级护理老年护理专家被指定为个案管理员，并协调多学科会议商定的护理工作。全科医生诊所作为单一入口点，监督护理协调工作。干预措施包括护士和医生之间的任务重新分配以及初级、二级和三级护理提供者之间的会诊。整个过程由多学科协议和基于网络的患者档案提供支持。
本研究设计为准实验性研究。在本研究中，将实施综合护理模式的三家全科医生诊所的205名体弱老年患者与提供常规护理的五家全科医生诊所的212名体弱老年患者进行比较。使用问卷对结果进行评估。通过卡方检验、t检验和回归分析将基线测量结果与三个月的随访结果进行比较。
短期内，综合护理模式对生活质量的依恋方面有显著影响。体弱老年患者能够更好地获得他们渴望的爱和友谊。尽管综合护理模式中有预防因素以及需要通过个案管理进行评估随访，但护理的使用情况并无差异。短期内，健康状况没有显著变化。由于衰弱是一种渐进状态，因此认为三个月时间太短，综合护理模式无法影响健康变化。需要采用更具纵向性的方法来研究综合护理对健康变化的价值以及对生活质量和医疗保健使用的积极影响的维持情况。
